Pharmacology IBD + PUD Flashcards
Infliximab classification
T: antirheumatics, DMARDS gastro-intestinal anti-inflm
P: monoclonal antibodies
Infliximab
Indication
Mechanism of action
Active rheumatoid arthritis, Crohn’s disease, ulcerative colitis
Neutralizes and prevents activity of TNF-alpha
(one of the cytokines that make up the acute phase reaction)
Infliximab
Side effects/contraindications?
- Contraindicated in HF
Common: fatigue, headache, upper resp infection, abdominal pain, nausea, vomiting
Severe = INFECTIONS, MALIGNANCY
Nursing implications for infliximab?
- Monitor for signs of systemic infection and infusion-related rxns
- Fatal TB assoc with this drug: recommended to be tested for latent TB before going on it
What are monoclonal antibodies?
mAb or moAb
an antibody produced by a single clone of cells or cell line and consisting of identical antibody molecules.
Prednisone
Class
Mechanism of Action/Indications
T: corticosteroids, immune modifiers
Used systemically and locally in wise variety of chronic diseaes including inflammatory, allergic, hematolic, neoplastic…etc
Suppresses inflm and normal IR. Replaces endogenous cortisol in deficient states
What drugs should be avoided in pt with PUD?
NSAIDs, prednisone….
Others?
Side effects of prednisone?
Common: depression, euphoria, anorexia, nausea, dec wound healing, adrenal suppression, osteoporosis, muscle wasting, cushingoid appearance (+ many more)
Severe: peptic ulceration, thromboembolism
Nursing considerations/assessments for pt on prednisone?
- Adrenal insufficiency: hypotension, weight loss, weakness, nauseam vomiting, anorexia, lethargy
- I/O, edema, rales/crackles
Salfasalazine
Class.
Mechanism of action/indications?
T: antirheumatics, gatro-intestinal anti-inflm
For ulcerative colitis, rheumatoid arthritis
Locally acting anti-inflm action in colon, action probably inhibition of prostaglandin synthesis
Side effects of salfasalazine?
Common: anorexia, diarrhea, nausea, vomiting, rash
Severe: aplastic anemia, angioedema, anaphylaxis + others
- Can cause male infertility
Nursing assessments/considerations r/t salfasalzine?
- Assess for allergy to sulfonamides/salicylates (dif breathing, rash, etc)
- I/O
- Abdominal pain, stools
What drugs r/t PUD?
1) Ranitidine
(Zantac)
2) Omeprazole
3) Aluminum Hydroxide
What drugs r/t IBD?
1) Prednisone
2) Sulfasazine
3) Infliximab
Ranitidine (Zantac) Classification? Mechanism of action? Indications?
T: Antiulcer agent
P: Histamine H2 receptor antagonist
Heartburn, ulcers, GERD, erosive esophagitis
Inhibits action of histamine at H2 receptor sites located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion
Side effects of ranitidine?
Common: Confusion
Severe: aarhythmias, aplastic anemia
H2RA can cause Vitamin B12 deficiency (stomach acid helpful in absorption)
-MS changes in elderly (?from class slides)
Important nursing considerations/assessments for ranitidine?
- Syrup contains alcohol
- Epigastric + abdominal pain, frank + occult blood, emesis
- CBC periodically
- Geriatric: look for confusion
Omeprazole
Class?
MoA and indications?
T: anti-ulcer agent
P: PPI
GERD/maintenance of healing in erosive esophagitis; duodenal ulcers
Binds enzyme on gastric parietal cells presence of acidic gastric pH, preventing final transport of H+ across lumen
Side effects of Omeprazole?
Generally well tolerated
Common: abdominal pain (can exp nausea, diarrhea, fatigue, dizziness)
Severe: pseudomembranous colitis
Nursing considerations for omeprazole?
= Containdicated in lactation
- May dec absorption of drugs requiring acidic pH
- GI + monitor bowel fx: diarrhea, cramping, fever, bloody stools,
- CBC
- Do not crush or chew (PPIs enteric coated d/t rapid degredation of drugs in acid conditions of stomach)
Aluminum hydroxide
Class?
MoA, indications?
T: anti-ulcer agents
P: Antacids-phosphate binders
Lowering of phosphate levels in pt’s with chronic renal failutre.
Adjunct tx for ulcers.
Binds phosphate in GI tract – neutralizes gastric acid and activates pepsin
Nursing implications for aluminum hydroxide?
- Pain
- Monitor serum phosphate + calcium levels when chronic use
- Chew first, take with glass of water
- May interfere with other meds
Ending of H2RAs?
-tidine
H2RAs
- Why are they used so widely?
- Adverse effects?
- Top pick for PUD b/c safe + effective
- Very rare to have side effects (Cimetidine has highest risk, esp in older adults)
WHat is the sole PPI available in injectible form?
Prantoprozole
When is it best to take PPIs and H2RAs?
30-60mins before meals
Nursing assessments for acid-controlling drugs (according to Lilley)
- GI fx/changes
- Liver + kidney fx
- Cardiac fx esp as relates to hx of Htn, HF, edema, electrolyte imbalances
- Very important to check drug interactions! (as are many)
- H2RA: kidney and liver fx, LOC (b/c of AEs)
- PPI: liver + kidney fx, drug interactions, bowel fx,
Why is it important to look at heart + kidney fx related aspects of pt on acid-controlling drugs?
Antacids have high sodium content…can lead to exacerbation of these issues
What changes in bowel fx are aluminum and magnesium based antacids?
Aluminum = constipation
Magnesium = diarrhea
* These often used in combo to balance these issues
Special considerations for calcium and sodium based antacids?
Calcium - risk for rebound hyperacidity, changes in systemic pH
Sodium bicarbonate - risk of alkalosis and electrolyte imbalance (watch heart + kidney fx)
WHat is an important consideration for timing of H2RAs if simultaneously taking antacids?
Space 1 hour apart
Antacids should be given with?
Why are they not recommended to be given with other meds?
At least 240ml of water to enhance absorption in stomach
Affect stomach acidity, thus influencing absorption of many other oral drugs